title: Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey.
abstract: OBJECTIVE
  To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana.
  
  
  METHODS
  Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression.
  
  
  RESULTS
  In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access.
  
  
  CONCLUSIONS
  Affordability was an important determinant of facility delivery in Ghana-even among women with health insurance-but social access variables had a mediating role.
authors.affiliation: Global REACH and Department of Medical Education, University of Michigan Medical School, Ann Arbor, USA. camoyer@umich.edu
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Moyer
authors.forename: Zoë M
authors.initials: ZM
authors.lastname: McLaren
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
mesh_terms: D000328:Adult; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016013:Likelihood Functions; D016015:Logistic Models; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D011247:Pregnancy; D012959:Socioeconomic Factors
keywords: Access to care; Africa; Facility-based delivery; Ghana; Healthcare utilization; Low-income countries; Maternal and child health